Medicaid by federal law has $ dedicated for skilled nursing care & skilled nursing care means care in a NH. And each state contributes its state by state share of the cost for Medicaid NH room & board.
What some states can opt to do with the $ is to have a “waiver” program that redirects a portion the dedicated skilled funding to go to other programs. For Medicaid to pay for AL it means that your state has a waiver program in place and have AL facilities that choose to participate in a waiver program. Most states DO NOT have AL waiver at all. Most facilities aren’t keen on participating in waiver programs as funding may not be there in a couple of years or state oversight for the few beds on Medicaid waivers is too cumbersome for a AL to warrant EVER getting involved in. If a AL can easily fill beds through private pay, there is no need to ever take waivers. Most AL is totally private pay. For the states - imo as an old health planner - from a cost benefit viewpoint if Medicaid combo funding is being redirected to waivers, it’s going to be better spend to instead have $ to wider population community based programs -like PACE - than a 1-on-1 AL program.
You just may find that your elder needs to be eligible for skilled nursing care in a NH in order to get Medicaid. If that’s the situation, you are going to need to work with their doctors to have a documented health history that clearly shows “need” for skilled. It may be that it’s only if their hospitalized and then discharged to a skilled nursing facility for rehab can they show the medical “need” that Medicaid requires for eligibility.
The way it works in my area is the ALs require 2yrs private pay before they will take Medicaid. And that is not a guarantee. They usually have only a % of Medicaid rooms available. ALs are for profit businesses. Your other choice would be a nice Nursing home that takes Medicaid. You profile says that Dad is already in an AL. Have you checked to see if they except Medicaid.
Sorry, but your question is hard to answer because being a forum we r from all over the US, Cananda, UK and have had other countries chime in. Each state runs Medicaid a little different. Also, what is available in ALs. There is a place on this site where you can put your state in and it will tell u what ALs are in your area. You will have to do the research concerning Medicaid.
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What some states can opt to do with the $ is to have a “waiver” program that redirects a portion the dedicated skilled funding to go to other programs. For Medicaid to pay for AL it means that your state has a waiver program in place and have AL facilities that choose to participate in a waiver program. Most states DO NOT have AL waiver at all. Most facilities aren’t keen on participating in waiver programs as funding may not be there in a couple of years or state oversight for the few beds on Medicaid waivers is too cumbersome for a AL to warrant EVER getting involved in. If a AL can easily fill beds through private pay, there is no need to ever take waivers. Most AL is totally private pay. For the states - imo as an old health planner - from a cost benefit viewpoint if Medicaid combo funding is being redirected to waivers, it’s going to be better spend to instead have $ to wider population community based programs -like PACE - than a 1-on-1 AL program.
You just may find that your elder needs to be eligible for skilled nursing care in a NH in order to get Medicaid. If that’s the situation, you are going to need to work with their doctors to have a documented health history that clearly shows “need” for skilled. It may be that it’s only if their hospitalized and then discharged to a skilled nursing facility for rehab can they show the medical “need” that Medicaid requires for eligibility.
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Sorry, but your question is hard to answer because being a forum we r from all over the US, Cananda, UK and have had other countries chime in. Each state runs Medicaid a little different. Also, what is available in ALs. There is a place on this site where you can put your state in and it will tell u what ALs are in your area. You will have to do the research concerning Medicaid.